Effectiveness of HDU in the immediate post operative management of two-stage oesophagectomy patients

Aims: To assess logistics and cost effectiveness of primary HDU care in the immediate post operative period up to day 5 following two-stage oesophagectomy (TSO) in a tertiary referral centre.

Methods: Sixty-one patients undergoing TSO between April 2003–March 2005 (24 months) were included in this prospective controlled study. Patients in the Group 1 (first 12 months, n=30) were planned for ITU admission post operatively. Patients in Group 2 (next 12 months, n=31) were assessed based on the performance status and admitted to HDU after TSO. These patient populations are compared in terms of feasibility of carrying out planned operations, duration of immediate postoperative ITU/ HDU stay and its cost implications.

Results: Group 1 had five cancellations due to unavailability of ITU bed. In Group 2 twenty-six patients satisfied the criteria and all these patients underwent operations as planned; none of them required ITU admission in the initial post-operative period. The median critical care cost for the patients in Group 1 was £4,900 compared to £3,000 in Group 2 (p<0.001). In-hospital mortality was zero in both groups.

Conclusions: Immediate post operative admission to HDU following TSO is practical, safe and cost effective in selected patient population.